Effects of Vaccination on Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Nationwide Population-Based Cohort Study

초록

BACKGROUND: Coronavirus 2019 (COVID-19) vaccination appears to have potential benefits for patients with chronic obstructive pulmonary disease (COPD). However, limited information is available on whether COVID-19 vaccination reduces acute exacerbation of COPD (AECOPD). METHODS: In the present study, 41,606 individuals with COPD were enrolled using the Korean National Health Insurance System-severe acute respiratory syndrome coronavirus 2 (NHIS SARS-CoV-2) database from 2020-2021. A total of 3,602 individuals were included in the analytical cohort through 1:1 propensity score (PS) matching between vaccinated and unvaccinated individuals. The risk of AECOPD was assessed using a Cox proportional hazards regression analysis. A post hoc analysis assessed the impact of COVID-19 on AECOPD in vaccinated and unvaccinated individuals, adjusting for differences between infected and uninfected groups. RESULTS: During the study period, the incidence of exacerbation was lower in vaccinated individuals (1,683/10,000 PY) than in unvaccinated individuals (3,410/10,000 PY). In the Cox proportional hazards regression model, the risk of AECOPD was significantly lower in vaccinated individuals compared to unvaccinated individuals (hazard ratio [HR) = 0.55, 95% confidence interval [CI] = 0.41-0.72). In the post hoc analysis, COVID-19 was associated with an increased risk of AECOPD among unvaccinated individuals after adjustment (adjusted HR = 2.06, 95% CI = 1.28-3.33). In contrast, among vaccinated individuals, the risk of AECOPD did not differ significantly between those infected and uninfected with COVID-19 (adjusted HR = 1.35, 95% CI = 0.42-4.36). CONCLUSIONS: COVID-19 vaccination may reduce the risk of AECOPD in individuals with COPD.

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